Antibiotic-Loaded Bone Cement for Infection Prophylaxis in Total Joint Replacement

Abstract

Use of antibiotic-loaded bone cement for prophylaxis against infection is not indicated for patients not at high risk for infection who are undergoing routine primary or revision joint replacement with cement. The mechanical and elution properties of commercially available premixed antibiotic-loaded bone-cement products are superior to those of hand-mixed preparations. Use of commercially available antibiotic-loaded bone-cement products has been cleared by the United States Food and Drug Administration only for use in the second stage of a two-stage total joint revision following removal of the original prosthesis and elimination of active periprosthetic infection. Use of antibiotic-loaded bone cement for prophylaxis against infection in the second stage of a two-stage total joint revision involves low doses of antibiotics. Active infection cannot be treated with commercially available antibiotic-loaded bone cement as such treatment requires higher doses of antibiotics.

Adding functionality with additive manufacturing: Fabrication of titanium-based antibiotic eluting implants

“…Two-stage exchange arthroplasty involves the implantation of an interim antibiotic-loaded component after removal of the original components. Commonly, antibiotic-loaded polymethylmethacrylate (PMMA) is used in the form of beads or cast into a mould and implanted [6], [7] and [8]. PMMA cements set via an exothermic reaction, reaching temperatures between 70 and 120 °C [9].…”

ε-Caprolactone in Micro-Chambered Ceramic Beads - A New Carrier for Gentamicin

“…The delivery from antibiotic-loaded bone cements depends directly upon the homogeneity of the mixture and the free surface of the PMMA implant [31,32]. According to the surface-related release, the morphology and the dimensions of the samples are decisive [33]. The release from carriers is extensively studied in different bone cements loaded with different antibiotics [9,14].…”

Evidenz- und konsensusbasierte österreichische Leitlinien für das Management akuter und chronischer unspezifischer Kreuzschmerzen

“…Da die operative Therapie solcher Veränderungen in Studien keine konsistenten Langzeiterfolge zeigte, muss, sofern eine Operation überhaupt möglich ist, die Indikation mit größter Zurückhaltung gestellt und die Patientenauswahl sorgfältigst getroffen werden. Außerdem rechtfertigt die derzeitige Datenlage, wenn überhaupt, ausschließlich Eingriffe, die auf zwei Wirbelsegmente beschränkt sind [85][86][87][88].…”